Peer Review Report For: Reforming organisational structures in Ethiopia’s immunisation programme: A policy brief [version 1; peer review: 1 not approved]

The Expanded Programme on Immunisation (EPI) in Ethiopia, established in 1980, has reduced child mortality and illnesses. Despite expanding immunisation services from 6 to 13 antigens, the EPI programme continues to operate under an organisational structure unchanged for over 40 years—posing significant challenges to its effectiveness. The current EPI structure, which places the EPI under a single desk within the Ministry of Health - Ethiopia (MoH-E) and even narrower at regional, zonal, and woreda (an administrative division in Ethiopia that is roughly equivalent to a district in other countries) levels is unable to accommodate the increasing demands of immunisation services. A national evaluation study conducted in August 2023 revealed critical staffing shortages. The study also identified operational inefficiencies at regional, zonal, local, and facility levels, where immunisation services are often integrated into other health units, leading to neglect and diffusion of responsibility. To address these challenges, this policy brief suggests restructuring the EPI at all administrative levels of the health system in Ethiopia, considering both current and future demands for EPI services. This includes establishing a dedicated National Vaccine and Immunisation Services Directorate, enhancing community-level engagement, and ensuring a clear delineation of roles and responsibilities.